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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020516
Report Date: 05/17/2021
Date Signed: 05/25/2021 04:27:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BADAMSAMBUU FAMILY CHILD CAREFACILITY NUMBER:
198020516
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/17/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Nomin BadamsambuuTIME COMPLETED:
01:28 PM
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Licensing Program Analyst (LPA) Justin Dorsey conducted a case management licensee initiated tele-inspection to the above facility. This was a tele-inspection due to COVID-19 pandemic. LPA met with Nomin Badamsambuu, Licensee, who guided analyst on a tour of the facility. The purpose of this inspection is due to licensee’s request for a capacity increase on 09/28/2021. Currently, the licensee’s capacity is eight, Licensee wishes to increase to a capacity of fourteen. Per Licensee, 2 adults and 2 children live in the home with her. All individuals present in the home have obtained a criminal record clearance. Per licensee, operation hours will be Monday to Friday 8:00AM to 5:30PM. There were 3 children present upon arrival.

This is a one story house which consists of 3 bedrooms 2 bathrooms, living room, dinning room, laundry room, kitchen, garage, front and backyard (fenced). Per licensee the children use the hallway bathroom, living room, dinning room, one bedroom and backyard. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service via cell phone, ventilation and heating. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children were observed to be inaccessible for children. LPA did observed a fireplace in the living room which is inaccessible for children.

Areas off limits to children and parents include: 2 of the homes bedrooms, 1 bathroom, office, and kitchen. Licensee understands that licensing staff may have access to off-limit areas during inspection visits if necessary. LPA Dorsey observed the facilities 2A10BC fire extinguisher was purchased 03/04/2020, per licensee she will buy a new fire extinguisher and send a picture of the receipt to LPA. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable. Fire/disaster drill log was available for review and last date of conducted fire drill was 05/17/2021 and Earthquake Disaster Drill was conducted 05/17/2021. LPA Dorsey observed the home's First Aid supplies.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 558-2710
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BADAMSAMBUU FAMILY CHILD CARE
FACILITY NUMBER: 198020516
VISIT DATE: 05/17/2021
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LPA discussed and provided documentation for the following regulations with the licensee: Ratio and Capacity and safe sleeping. LPA also emailed documents to Licensee.

This facility currently does not have any children on medication.


Licensee is seeking to provide care for 14 children ages 3 months to 8 years old. A fire clearance has been granted as of 03/01/21.

Increase may/will be granted depending on LPM (Licensing Program Manager) approval.

Licensee was given PIN 20-24-CCP regarding Safe Sleep Awareness Campaign. Initials here confirms PIN 20-24-CCP was received by Licensee. Initials: ____________


Corrections needed before license can be approved:


1.) The licensee will send LPA Dorsey a picture of the receipt when the licensee buys a new fire extinguisher.

LPA Dorsey observed a RAST visit was conducted 08/21/20.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview was conducted with Nomin Badamsambuu, during which appeal rights were explained. This report along with a copy of appeal rights will be sent to the Licensee via email with a read receipt and confirmation of receipt of email. Licensee will sign an original copy of the report and mail to LPA.



SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 558-2710
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC809 (FAS) - (06/04)
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